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Anthem Full Dual Advantage (HMO D-SNP)
The Centers for Medicare & Medicaid Services (CMS) publishes annual Star Ratings that reflect how each Medicare Advantage plan performs across a range of metrics, using a system of one to five stars.
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Monthly Premium
Anthem Full Dual Advantage (HMO D-SNP) is a HMO D-SNP plan offered by Anthem Inc.
Plan ID: H2628-003
HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.
Medicare beneficiaries may find it helpful to review available Medicare Advantage plans in their area. Medicare Advantage plans are designed to combine the coverage offered from Original Medicare (Medicare Part A and Part B) while also offering additional benefits.
Many Medicare Advantage plans may cover prescription drug coverage as well as additional benefits such as Dental, Vision and Hearing.
Learn more about Medicare Advantage plans such as Anthem Full Dual Advantage (HMO D-SNP) - H2628-003 by Anthem Inc. as well as other Medicare Advantage plans available in your area.
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Monthly Premium
Ohio Counties Served
AdamsAllenAshlandAshtabulaAthensAuglaizeBelmontBrownCarrollChampaignCoshoctonCrawfordDarkeDefianceErieFairfieldFayetteGalliaGuernseyHancockHardinHarrisonHenryHighlandHockingHolmesHuronJacksonJeffersonKnoxLawrenceLickingLoganMarionMeigsMercerMiamiMonroeMorganMorrowMuskingumNoblePauldingPerryPikePreblePutnamRichlandRossSanduskySciotoSenecaShelbyTuscarawasVan WertVintonWashingtonWilliamsWyandot
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Monthly Deductible | $615 |
| Out of Pocket Max |
In-Network: $9250 Out-of-Network: N/A |
| Initial Coverage Limit | $0 |
| Catastrophic Coverage Limit | $2100 |
| Primary Care Doctor Visit | In-Network: $0.00 copay |
| Specialty Doctor Visit | In-Network: $0.00 copay |
| Inpatient Hospital Care | In-Network: $0.00 copay per stay |
| Urgent Care | Urgent Care: $0.00 copay |
| Emergency Room Visit | Emergency Care: $0.00 copay Worldwide Coverage: This plan covers urgent care and emergency services, including emergency transportation, when traveling outside of the United States for less than six months. This benefit is limited to $100,000 per year. |
| Ambulance Transportation | Ground Ambulance: $0.00 copay Per Trip Air Ambulance: $0.00 copay |
Health Care Services and Medical Supplies
Anthem Full Dual Advantage (HMO D-SNP) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).
| Coverage | Cost |
|---|---|
| Chiropractic Services | In-Network: Medicare Covered Chiropractic Services: $0.00 copay |
| Diabetes Supplies, Training, Nutrition Therapy and Monitoring | In-Network: Diabetic Supplies: $0.00 copay |
| Durable Medical Equipment (DME) | In-Network: $0.00 copay |
| Diagnostic Tests, Lab and Radiology Services, and X-Rays | In-Network: Lab Services: $0.00 copay X-Rays: $0.00 copay Therapeutic Radiological Services: $0.00 copay Outpatient Diagnostic Procedures/Tests: $0.00 copay Diagnostic Radiological Services: $0.00 copay |
| Home Health Care | In-Network: $0.00 copay |
| Mental Health Inpatient Care | In-Network: $0.00 copay per stay |
| Mental Health Outpatient Care | In-Network: Individual and Group Sessions: $0.00 copay |
| Outpatient Services / Surgery | In-Network: Outpatient Hospital - Surgery: $0.00 copay Observation Services: $0.00 copay Ambulatory Surgical Center: $0.00 copay |
| Outpatient Substance Abuse Care | In-Network: Individual and Group Sessions: $0.00 copay |
| Over-the-counter (OTC) Items | |
| Podiatry Services | In-Network: Medicare Covered Podiatry Services: $0.00 copay Routine Foot Care: $0.00 copay Unlimited routine foot care visits each year. |
| Skilled Nursing Facility Care | In-Network: $0.00 copay per stay |
Dental Benefits
The following dental services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Dental Care | This plan covers oral exams, 1 cleaning every 6 months, and dental X-rays every year. This plan covers comprehensive dental services including restorative, endodontic periodontic, and surgical extractions. Require prior authorization for most of these dental services. In-Network Medicare Covered Dental: $0.00 copay Preventive Dental: $0.00 copay Comprehensive Dental: $0.00 copay |
Vision Benefits
The following vision services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Vision Benefits | In-Network: Medicare Covered Eye Exam: $0.00 copay Routine Eye Exam: $0.00 copay This plan covers 1 routine eye exam(s) every year. Medicare Covered Eye Wear: $0.00 copay Routine Eye Wear: $0.00 copay This plan covers up to $300 for eyeglasses or contact lenses every year. |
Hearing Benefits
The following hearing services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Hearing Benefits | In-Network: Medicare Covered Hearing Exam: $0.00 copay Routine Hearing Exam: $0.00 copay for routine hearing exam(s). $0.00 copay for hearing aids up to the maximum plan benefit amount. This plan covers 1 routine hearing exam every year. $300 maximum plan benefit for over-the-counter hearing aids OR 1 routine hearing aid fitting evaluation and a $3,000 maximum plan benefit for prescribed hearing aids every year. |
Preventive Services and Health/Wellness Education Programs
The following services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Preventive Services and Health/Wellness Education Programs | In-Network: $0.00 copay for Medicare Covered Preventive Services |
Prescription Drug Costs and Coverage
The Anthem Full Dual Advantage (HMO D-SNP) plan offers the following prescription drug coverage, with an annual drug deductible of $615 (excludes Tiers 1 and 6) per year.
| Coverage |
Cost
|
|---|---|
|
Coverage & Cost
|
|
| Annual Drug Deductible | $615 (excludes Tiers 1 and 6) |
| Preferred Generic |
|
| Select Care Drugs |
|
| Annual Drug Deductible | $615 (excludes Tiers 1 and 6) |
| Preferred Generic |
|
| Select Care Drugs |
|
| Annual Drug Deductible | $615 (excludes Tiers 1 and 6) |
| Preferred Generic |
|
| Select Care Drugs |
|